Part II Male

Information Collection Request, Review, and Approval System (ICRAS)

History

Forms

Files

Page 1 of 2

Submit

0920-0314 - National Survey of Family Growth, Cycle 7
You are not permitted to edit this package at this time!
PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET
Part II: IC Details
[?] 1. Title National Survey of Family Growth Cycle 7 Year 3 Male Questionnaire
[?] 2. Is this a Common Form?

[?] 3. Obligation to respond:

[?] 4. Frequency of reporting (check all that apply)

Yes

Voluntary

Hourly (40 per week)

Every Decade

No

Required to obtain or retain benefits

Daily

Quarterly

N/A

Mandatory

Weekly (52 per year)

Semi-annually

Monthly

Biennially

Yearly

Once
Occasionally

[?] 5. CFR Citation(s) for the information collection under review (if applicable).
Current Citations: None
Add Instrument

[?] 6. Instruments:

Name

Size
(kb)

NSFG
MaleCapiLite_Y3OMB_Jan08.doc

749.00

Sort

Form
No.

Form
Name

URL

Electronic
Capability
Fillable
Printable

Avail.
Electronically?

Submitted
Electronically?

Document
Type

Yes

Yes

Other

Add Document

Additional Documents:

[No attachments have been added]
[?] 7. Federal Enterprise Architecture Business Reference Model (Required for any Reporting Requirements)
Line of Business Health
Subfunction

Public Health Monitoring

See http://www.whitehouse.gov/..../FY07_Ref_Model_Mapping_QuickGuide.pdf for the Business Reference Model categories and definitions.
[?] 8. Privacy Act System of Records (if applicable)
Title: Health and Demographics Surveys Conducted in Probability Samples of the U.S. Popu
Federal Register Citation:
Volume 49

Page number 37693

Publication date 09/25/1984

9. Respondents
[?] Total #

1957

Individuals or households

[?] Small Entity #

0

Private Sector

(mm/dd/yyyy)

[?] Affected public

[?] Percent Electronic 100

(if Private Sector
check all that apply)
Business or other for-profits

State, Local, or Tribal Governments

%

Federal Government

Not-for-profit institutions
Farms

[?] 10. Frequency: How often on average will each respondent respond to the Information Collection?
Number of Responses per Respondent 1.0000000000

per Year
(Select the most appropriate time period for this collection)

[?] Calculated: Annual Frequency = 1 times a year (per respondent)
[?] Calculated: Annual Number of Responses = 1957 a year
[?] 11. Hour and Cost Burden
Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.
Time per
Hour per
Annual
Response
Response
Hour Burden
Reporting

56.0000000000

in Minutes

= 0.9333333333333333 1826.5333333333

Record keeping

0

in Hours

=

0

0

Third party disclosure 0

in Hours

=

0

0

Total

0.9333333333333333 1826.5333333333

http://hhs.paperworkreduction.gov/lo/modern/package/search/pkg/8848/part2s/edit/24799

2/13/2008

Information Collection Request, Review, and Approval System (ICRAS)

Page 2 of 2

(Cost calculations should match the Supporting Statement Section A, question 13.)
Cost per
Response

Annual
Cost Burden

Reporting

$ 0.0000000000

$0.0000000000

Record keeping

$ 0.0000000000

$0.0000000000

Third party disclosure $ 0.0000000000

$0.0000000000

Total

$0.0000000000

$0.0000000000

[?] 12. Annual Responses and Burden.
Program Change:
Total
Requested

(Due to
New Statute)

(Due to
Agency Discretion)

Change Due to
Adjustment in
Agency Estimate

Change Due to
Violation

Currently
Approved

Annual
Responses

1,957

0

1,957

0

0

0

Annual
Hour
Burden

1,827

0

1,827

0

0

0

$ 0

$ 0

$ 0

Annual Cost
0
Burden

$ 0

$ 0

Save Draft

Save & Validate

http://hhs.paperworkreduction.gov/lo/modern/package/search/pkg/8848/part2s/edit/24799

2/13/2008